Dementia-related work activities of home care nurses and aides: Frequency, perceived competence, and continuing education priorities

Morgan, Debra; Kosteniuk, Julie; O’Connell, Megan E; Bello-Haas, Vanina Dal; Stewart, Norma J.; Karunanayake, Chandima

doi:10.1080/03601277.2015.1083390

Cited by 19 publications

(25 citation statements)

References 29 publications

(28 reference statements)

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“…We found familiarity with care for many common physical and mental ailments, yet the VHTs reported the need for training with specific to dementia care to equip them with knowledge and skills on early detection and management, care and referral systems. These findings are consistent with Morgan et al who argues that health providers need to be equipped with capacity and skills in helping people with health needs in our case who elderly individuals with dementia (20). This training is imperative for VHTs who are not professionals in the health field, as this training will equip them with necessary skills in dementia care and management in their respective communities.…”

Section: Needs Assessmentsupporting

confidence: 88%

Community-based management and care of people with dementia: A training needs assessment among village health teams in Uganda based on WHO guidelines

Karungi

Obua

Rukundo

et al. 2019

Preprint

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Background Dementia is a public health problem worldwide with approximately 47 million people living with the disease. Although the symptoms are known and named, dementia remains a hidden problem in low and middle income countries (LMICs) as most people perceive it be a normal aging process. In a bid to improve healthcare, the Uganda government adopted a model of recruiting community-based health assistants known as village health teams (VHTs). These individuals helped in linking the community health units with community members with a goal of promoting health services. However, there is paucity of information about how the VHTs provide community-based management and care for people with dementia and their ability to perform the task. The purpose of this study was to identify the training needs of the VHTs in caring for people with dementia in rural communities of southwestern Uganda.Methods This study utilized a cross-sectional qualitative design conducted with the help of semi-structured interview guide. The WHO guide was adopted in developing interviews on dementia care and management in LMICs.Results From the study, VHTs reported the need for training with specific to dementia care to equip them with knowledge and skills on early detection and management, care and referral system. Results also show that VHTs were not able to detect dementia early since they perceive it as normal aging process. There was no community engagement in helping people with dementia since most people in the community do not take dementia to be a medical condition. Also there was little support for dementia in these areas as VHTs only referred people with dementia to health facilities in an event of physical ailment. Other organisations like churches only offered prayers only to the aged persons who are very close to the church.Conclusions The study found that there is an urgent need for training VHTs on caring for individuals with dementia in rural communities of southwestern Uganda. The identified gaps helped in designing the strategies for capacity building through training of VHTs on dementia care in rural communities of southwestern Uganda.

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Section: Needs Assessmentsupporting

confidence: 88%

Community-based management and care of people with dementia: A training needs assessment among village health teams in Uganda based on WHO guidelines

Karungi

Obua

Rukundo

et al. 2019

Preprint

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“…Most participants reported that e-learning was unengaging, generic and resulted in little, or no, skills and knowledge development. These findings are reiterations of those in many other studies indicating little progress in this area and suggesting the need for a continued effort towards developing and trialling engaging and appropriate educational programmes for these staff [22, 23, 72]. Few studies have been completed in this regard; however, positive outcomes for HCAs’ confidence, motivation to engage in care and reporting to professionals have been reported following practical skills training in palliative care [73].…”

Section: Discussionmentioning

confidence: 54%

“…Such assessments occur when knowledge and understanding of patients’ normative patterns of behaviour, physical and cognitive functioning and past reactions to pain are used to inform recognition and interpretation of behavioural and nonverbal pain cues [34]. Daily care provision brought HCAs in this study into close physical and social contact with residents, allowing them to develop a comprehensive knowledge and understanding of their care-recipients over time [19–22]. In most cases, changes in residents’ norms prompted HCAs to observe for behavioural and nonverbal indictors of pain and interpret them within contextual knowledge of the resident.…”

Section: Discussionmentioning

confidence: 99%

“…making beds, laying tables for meals) [16–21]. These staff spend more time with patients than any other healthcare professional and often develop detailed knowledge of patients’ preferences, routines, and normative patterns of behaviour, mood, appetite and disposition [19–22]. As a result, they are often the first to recognise and alert professional staff to changes in patients’ physical and cognitive functioning [22].…”

Section: Introductionmentioning

confidence: 99%

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Exploring healthcare assistants’ role and experience in pain assessment and management for people with advanced dementia towards the end of life: a qualitative study

Jansen

Brazil

Passmore³

et al. 2017

BMC Palliat Care

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BackgroundPain assessment and management are key aspects in the care of people with dementia approaching the end of life but become challenging when patient self-report is impaired or unavailable. Best practice recommends the use of observational pain assessments for these patients; however, difficulties have been documented with health professionals’ use of these tools in the absence of additional collateral patient knowledge. No studies have explored the role, perspectives and experiences of healthcare assistants in pain assessment and management in dementia; this study provides insight into this important area.MethodsA qualitative approach was adopted, using key informant interviews with healthcare assistants caring for people with advanced dementia approaching the end of life in hospice, nursing home and acute care settings. Thematic analysis was the analytic approach taken to interpretation of interview data. Data were collected between June 2014 and September 2015.ResultsFourteen participants took part in the study. Participants’ average length of caring experience was 15.4 years and most were female. Three key themes emerged: recognising pain, reporting pain, and upskilling. Participants were often the first to notice obvious causes of pain and to detect changes in patient norms which signified hidden causes of pain. Comprehensive knowledge of resident norms enabled participants to observe for behavioural and nonverbal indicators of pain and distinguish these from non-pain related behaviours. Pain reporting was heavily impacted by relationships with professional staff and the extent to which participants felt valued in their role. Positive relationships resulted in comprehensive pain reports; negative relationships led to perfunctory or ambiguous reporting. Participants emphasised a desire for further training and upskilling, including in the use and reporting of basic pain tools.ConclusionsHealthcare assistants are frontline staff who have a key role in direct patient care, spending a considerable amount of time with patients in comparison to other health professionals. These staff are often first to notice changes in patients that may signify pain and to alert professional staff. However, to ensure the quality of these reports, further efforts must be made in reversing stigma attached to this role and in upskilling these members of the healthcare team.

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“…These realities highlight the need to better understand and develop a confident, competent and engaged nursing workforce in rural and remote settings. Although a few studies have examined factors associated with competence in rural nursing practice (e.g., Morgan et al, ), they are mainly descriptive in nature and examine small, linear elements of proposed relationships. There is a need for deeper exploration of competence and confidence in rural and remote nursing practice using multivariate modelling.…”

Section: Introductionmentioning

confidence: 99%

Competence and confidence in rural and remote nursing practice: A structural equation modelling analysis of national data

Penz

Stewart

Karunanayake

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To empirically test a conceptual model of confidence and competence in rural and remote nursing practice. Background The levels of competence and confidence of nurses practising in rural settings have been highlighted as essential to the quality of health outcomes for rural peoples. However, there is limited research exploring these constructs in the context of rural/remote nursing practice. Design Structural equation modelling was used to verify the conceptual model with data from the cross‐sectional pan‐Canadian Nursing Practice in Rural and Remote Canada II Survey. The STROBE guidelines for cross‐sectional research were followed in the design/reporting of this analysis. The sample consisted of 2,065 registered nurses and nurse practitioners who were working in direct rural/remote nursing practice. Results The maximum likelihood ratio χ2 = 0.0822, df = 2, p = 0.959 indicated model fit, with final model estimates explaining 53% of the variance in work confidence and 17% of the variance in work competence. The model also accounted for 40% of the variance in work engagement, 39% of the variance in burnout and 15% of the variance in perceived stress. The complexity of competence and confidence in rural nursing practice was evident, being influenced by nursing experience in rural settings, rural work environment characteristics, community factors and indicators of professional well‐being. Conclusions The factors influencing nurses’ competence and confidence in rural/remote nursing practice are more complex than previously understood. Our model, created and tested using structural equation modelling, merits further research, to extend our understanding of how nurses can be prepared and supported for practice in rural and remote settings. Relevance to clinical practice This study highlights the importance of supporting new nurses’ exposure to rural nursing experiences, reducing professional isolation and improving decision‐making support for those who are working at a greater distance from colleagues and/or those with fewer opportunities for interprofessional collaboration.

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Dementia-related work activities of home care nurses and aides: Frequency, perceived competence, and continuing education priorities

Cited by 19 publications

References 29 publications

Community-based management and care of people with dementia: A training needs assessment among village health teams in Uganda based on WHO guidelines

Community-based management and care of people with dementia: A training needs assessment among village health teams in Uganda based on WHO guidelines

Exploring healthcare assistants’ role and experience in pain assessment and management for people with advanced dementia towards the end of life: a qualitative study

Competence and confidence in rural and remote nursing practice: A structural equation modelling analysis of national data

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